How can a singing teacher support a student recovering from Covid-19? Sarah Nixey, who is managing her own vocal recovery after a serious brush with the virus, shares her tips.

While our understanding of Covid-19 has grown enormously over the past few months, there is so much we still don’t know about the novel virus. One aspect of Covid-19 that is the subject of much research – and is of particular relevance to singing teachers – is the long-term effects of the disease on those who survive it.

While many people who contract Coronavirus bounce back within 14 days, a small but significant group suffer post-Covid syndrome – lingering viral symptoms that can come in waves or be ongoing. Symptoms include breathlessness, lung burn, muscle pain, dizziness, fatigue, difficulty sleeping, concentration issues, fever and coughing.

Singer Sarah Nixey is still recovering, months after contracting Covid-19.

To get a better insight into how Covid-19 can impact a singer, and how best to support vocal recovery, BAST spoke to Sarah Nixey. Best known for her work with Black Box Recorder, the singer has post-Covid syndrome or what is sometimes called “long-tail” symptoms of the virus.

She came down with Covid-19 in mid-March and was very ill for several weeks (although she avoided hospitalisation). Three months on she still experiences fatigue, lung burn and muscle ache. Every six or seven days Nixey is also hit with a bout of illness that lasts two to three days and includes coughing episodes, headaches, breathlessness on exertion, and anxiety.

How did Covid-19 affect your voice?

When I had the virus, my throat became sore, as if I had inhaled dust, and then thick with mucus. The persistent cough was exhausting, and I think my vocal folds became very swollen and inflamed. During the second week of illness, my voice was hoarse, and then I gradually experienced complete voice loss. It took another two to three weeks to slowly come back to full speaking volume. By week five, it was beginning to feel like I might be able to start to sing. Over the past month, my voice has improved significantly.

Have you tried to sing since you started to recover from Covid-19?

I started singing again at around week six. At first, I didn’t sound like me, and that was quite unnerving. My voice was quieter, much less stable, and very quickly became tired. Although I knew what was happening and that it would take time, I still felt quite concerned about the journey I would have to embark on to get back to full strength. The virus had affected my physical and mental health and learning to be patient with myself was difficult. There was some comfort in knowing that many other people were also off work and that I had time to plan some kind of at-home rehabilitation.

Do you have a voice recovery plan?

Yes, it includes following all the usual vocal health advice: plenty of water; not speaking too loudly or for long periods; trying not to clear my throat too often; no alcohol; and no caffeinated drinks. I’ve taken lots of antibiotics, inhalers and hayfever pills too, and I’m aware of the drying affect all of these can have on the vocal folds. I have been using a nebuliser with saline, and a humidifier during the night has reduced the coughing episodes by adding moisture to the air. The usual method of inhaling steam – a bowl of hot water and a towel over the head – has also helped clear congestion.

Emotional stress also affects the voice, so knowing when to relax and take some time out is important. Deep breathing and meditation help.

Right now, I’m mainly using SOVT and breath management exercises and singing songs I’ve written. I’m not overusing my voice but exploring what I can do at this moment. I don’t have any gigs or recording sessions lined up yet so there’s no pressure to be ready. I’m using this time to recover fully, be with my family and write songs.

What are your teaching tips when working with a student who has had Covid-19?

It depends on what your student has been through. Take some time to listen to their experience and find out where they are in terms of their speaking voice. Seek advice from your singing community if need be. There is lots of research into how the virus affects people physically and psychologically, and the secondary infections associated with it. It may be worth looking at the British Medical Journal website and newspaper articles written by, or interviews with, medical professionals.

For many singers who have suffered this illness, it will be a vocal and emotional recovery. Lesson planning may be difficult during this time due to fluctuating symptoms, physical and vocal fatigue, and reduced concentration levels. Think about starting with 30-minute lessons, and then see how the student progresses.

A mild dose of the virus is perhaps more akin to dealing with the aftermath of flu: inflamed and swollen vocal folds, fatigue and other mild symptoms. Moderate cases will usually involve some lung damage, inflamed and swollen vocal folds, and perhaps post-viral symptoms like the ones I have already described. If they’ve had a secondary infection, there may be some lasting issues of pneumonia. Be mindful of mental health concerns: low mood, anxiety, fear of further illness, flashbacks and poor sleep.

The more severe cases, where someone has been in intensive care, may require a GP referral to an ENT specialist Voice Clinic. The recovery period will be longer, and you will need to be guided by the student’s medical advisors.

How should a teacher approach the situation?

It’s important to advise on general vocal health initially. Read as much as you can around the subject. In terms of your approach, tailor the lessons to your student’s needs and wants, as always.

More specifically, you may wish to explore:

Alignment

The student may have spent long periods in bed, laying down or sitting, therefore observe their posture and suggest stretches, core strengthening exercises, and anything else you feel comfortable teaching. Be guided by the student’s medical conditions and refer them on to someone else with more expertise if the need arises.

Breathing exercises

Abdominal breathing and lung expansion exercises, and then extending the out-breath, have all helped me. Be careful with dizziness as this can be a post-viral symptom. There are lots of ideas on the British Lung Foundation website. Phoene Cave has also done extensive work in this field and it’s worth looking at her exercises.

Vocal play

Use everyday speech sounds to get back into singing. Dr Meribeth Dayme’s Easy Vocal Warm-Ups are great for this. They will also help with vocal fold closure. Keep it fun and playful.

SOVT exercises

You could try straw-in-water exercises at first, then gentle humming and buzzing sirens, extending to short scales of maybe three or five notes.

Specific technical exercises

You will need to be guided by the student here. This is the part you probably can’t plan.

Repertoire

When your student is ready, ease your way into singing songs by choosing something that they are familiar with, and that isn’t too athletic.

Cool down

Check the larynx hasn’t crept up too high by listening to their speaking voice at the end of the lesson. Some lower pitch humming or reverse vocal fry for a couple of minutes will aid this. Listen for any other issues that weren’t there before singing. Has there been an improvement? Is anything worse than before? Any pain? Keep notes.

Draw up a simple vocal recovery plan with your student. Set some goals and decide on how much practice they can do between lessons.

What issues should they be mindful of?

If the student’s speaking voice hasn’t completely returned after six weeks, I would ask them to see their GP. Equally, if they are still experiencing any throat pain or loss of voice anywhere in their range, their GP will be able to refer them to a specialist. Where possible, they should insist on a specialist Voice Clinic.

Look and listen for any straining, breathiness and other vocal issues as you normally would. Take little steps and progress when you both feel the need for more challenging technical exercises and repertoire. Also, listen for vocal fatigue, and take more breaks in the lesson than usual. Find a way of using the lesson productively if they need time for the vocal folds to recover at any point. Listen to other artists, teach music theory or educate them about their voice.

What’s your advice for singers who have had Covid-19?

Aim to use your normal voice, avoiding whispering or straining to be heard. My three children had to adapt to my voice issues quite quickly, moving in to listen to me speak, and not shouting to me from other rooms, expecting a reply. If you live with other people, they need to know how to support you, even if they are very young.

If you have complete voice loss, not speaking at all may also be detrimental. Humming and small utterances throughout the day will help to mobilise that area. Speak to your GP if you have any concerns. You may wish to consider having a laryngeal massage when it’s possible. Ask your teacher if they have any recommendations.

If you experience a setback or relapse, remember to rest. The British Voice Association has a section on vocal care and COVID-19, and you can refer to this when needed.

Remember that changes to your voice are more often than not temporary. Follow the guidance from your teacher regarding vocal health and do your research. Knowledge is power. You will be a better singer if you educate yourself as to how the voice works and how to look after it.

For more resources on managing post-Covid syndrome visit Sarah’s Covid-19 diary and home care blog.